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Zorluk: ZorEthical Practice

A 45-year-old client is admitted to an inpatient psychiatric unit on an involuntary 72-hour hold due to severe psychosis. The client refuses their scheduled oral antipsychotic medication, stating, "That poison will steal my thoughts." The client is currently pacing the dayroom and muttering but is not exhibiting any aggressive or threatening behavior towards themselves or others. A colleague suggests crushing the medication and mixing it into the client's morning juice. Based on ethical and legal principles, which of the following is the most appropriate action by the nurse?

  1. Acknowledge the client's concerns, document the medication refusal, and notify the healthcare provider, as the client retains the right to refuse treatment.Cevap
  2. B
    Administer the medication crushed in the client's juice while telling them it is a specialized vitamin supplement to ensure they receive the necessary treatment.
  3. C
    Delegate the task of mixing the medication into the client's food to an Unlicensed Assistive Personnel (UAP) to avoid damaging the primary nurse-client bond.
  4. D
    Immediately obtain a prescription to apply physical restraints and administer an intramuscular formulation of the antipsychotic to prevent potential violence.

Cevap

The most appropriate action is to acknowledge the client's concerns, document the medication refusal, and notify the healthcare provider, as the client retains the right to refuse treatment.
The correct answer upholds the ethical principle of autonomy and the client's legal right to informed consent. In most jurisdictions, an involuntary admission (such as a 72-hour hold) temporarily removes a client's right to leave the facility but does not strip them of the right to refuse medical or psychiatric treatment. Unless there is a separate legal mandate (such as a medication capacity hearing or court order) or an acute psychiatric emergency where the client is an imminent physical threat to themselves or others, the nurse must respect the refusal, document it, and notify the provider.

Adım Adım Çözüm

1
Assess the client's current status and behavior.
The client is pacing and muttering but is not an imminent danger to themselves or others.
To determine if an acute emergency exists that would justify overriding the right to refuse medication.
2
Evaluate the client's legal status and rights.
The client is on an involuntary hold but does not have a specific court order for mandatory medication administration.
Involuntary admission alone does not remove the client's right to informed consent and treatment refusal.
3
Apply ethical principles to the situation.
The nurse must uphold the principles of autonomy and veracity, rejecting suggestions to deceive or force the client.
Covert administration or unnecessary restraints violate ethical nursing practice and destroy the therapeutic relationship.
4
Determine the appropriate nursing intervention.
The nurse documents the refusal and communicates with the provider.
To ensure continuity of care while respecting the client's autonomy and legal rights.

Anahtar Kavram

Ethical Practice: Right to Refuse Treatment in Involuntary Admissions
Tahmini Süre:1m 30s
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Ethical Practice

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